Week Eleven Day Two: Bracing

As the project is coming to a close, my last day being tomorrow, I wanted to make sure I addressed the other form of treatment for scoliosis: bracing.

Bracing is usually done when a child's curve is not yet high enough to be operated on, but still at risk for progressing, which is dependent on age, the degree of the curve, and physical maturity.

The brace is a full back brace that must be worn 16+ hours a day. It does not reduce the curve by any means, however it does slow the progression of the curve, and hopefully prevent children from having to go through the surgery.

Most braces can be worn under clothes, and Doctor Shindell recommends that it's worn all day and night except for school. It's formatted personally to each kid's body, by a professional.

Generally this brace is called a Boston brace, and does not necessarily look like the one above, but similar, with straps to hold it in place.

Although it does not reduce the curve, it is a much less invasive option that can slow the road to surgery, or even stop it completely.

Week Eleven Day One: Risser Sign

As my project is coming to a close this week, and tonight I'm finalizing my presentation and nearing the end of my research paper, I wanted to talk about one more thing that I'm not sure I've addressed so far on this blog: risser signs.

A risser sign is a cap that forms over the pelvis in teenagers. For girls, it forms during their last year or two of growth, informing doctors that she's reaching her full maturity and height. However it's different in boys, as it isn't as reliable and they still grow following the caps formation.

Doctors use this cap by labeling it risser sign 0, 1, 2, 3, 4 or 5, based off how far the cap has developed over the pelvis.

By using this as an indicator in female patients, doctors can figure out how they want to treat a patient. For example, if a patient has risser sign 5, and only has 16 degrees of curvature, it is very unlikely that the curve will progress due to the fact that she's done growing, and that scoliosis in children is not degenerative and instead genetic.

Above is a picture showing what the cap would overall entail and what each risser sign means.
Below is a picture of a risser sign on an x-ray.

If you look at the pelvis you can see a little cap forming over it, that is the risser sign.

Week Ten Day One: A Slow Week/Familial Influence

Coming back from my break was a bit harder than I expected in terms of sleeping, but I'm now back in the hang of things.

So far I've seen some pretty interesting patients this week, however it has been slow when it comes to patients who have had the spinal fusion.

Of course this project is not solely based on studying my research question, or else I'd be bored out of my mind, but also learning about other things related to the medical field and seeing what it's like being inside a patient room not as a patient.

One thing I noticed a lot of this week was how the family truly affects the level of care, even with the same doctor.

If Dr.Shindell puts a cast on two kids in the same spot at the same time, but one kid's parents let them run around and not wear a sling, the affects will not be the same as the kid who doesn't. Although many people assume your level of care is based on your doctor and that alone, it's not true. The family plays a huge role in the kids level of success after care, and their ability to get the correct care in the first place (such as families forgetting what happened to cause an injury).

It's a simple thing to keep in mind when you think of doctor's and how their patients are, but it's a very important topic to also be discussed.

Week Nine Day Two: Spinal Fusion Vs. MAGEC Rods

So as this week's coming to a close, I will not be here next week and posting as I am going to Hawaii! I'm very excited.

Now looking at my data, I thought I had a set number but apparently I was wrong. It's very late in the project, so I cannot try and change anything about it, but there are some things I realized:

For scoliosis, there two surgeries, the spinal fusion for kids that are fully grown, and the MAGEC rod system for kids that are still growing. If I shaped my question to "scoliosis surgeries" I would have 13 data points rather than the 9 I have now, and they would include more complications and a better way of analysis.

I'm trying to find a way to get more data if I can, but the project is so near over it seems very difficult.

I made a post early about the MAGEC rods so you can go check it out.

I hope everyone has a great week!

Week Nine Day One: Understanding the Mental Health As Not Being a Complication.

Well seniors! The project is almost coming to a close, and I hope everyone is getting excited about college and their future. With my project ending soon, I'm trying to nail down and get a full grasp on some of the definitions I'm using for my presentation, the main one being complication, which I'm defining as an unexpected and unwanted consequence of the surgery.

Most of the time this means physical complications such as the progression of the curve of the spine following the insertion of the rods, lose screws, breaking of the rods, etc. But today, after seeing a patient who's gone through multiple surgeries and is suffering from unhappiness (I cannot define it as depression since I do not know) it made me think about whether or not there can be mental complications following the surgery.

Before the spinal fusion surgery, some people may have to quit sports or activities that they enjoy, which can cause a depressive state. In most cases, from what I believe, doctors are on the look out for the patient's mental state, before, during, and after the surgical process, as it can be "expected" for their to be some sort of unhappiness given the discomfort patients must endure.

In that case, it wouldn't be a complication, as most doctors can expect/must look out for this, however depression wouldn't be the only possible mental side affect.

Through reading Scoliosis: Ascending the Curve I found that some people began to have anxiety following their surgery surrounding crowds, or sports even after their doctor has given them permission to continue doing said sport. Some people are fearful of being bumped into, and therefore can suffer social or crowd anxiety.

In cases like these, it can also be considered understandable reaction, and though unwanted, it isn't necessarily unexpected.

So for the sake of this project, and me gathering up the small amount of data that I have, mental side affects are not considered a complication.

Week 8 Day Two: Why This is Important To Me.

Before research projects are funded, the real question people ask is why is this important? Why could this research be a benefit to us and our society? In this post, I'm going to take this question and change it a bit, and answer why this is important to me.

This post will conclude my mini 3 part endeavor into my personal journey with scoliosis spinal fusion surgery and its complications.

In my last post I talked about how I had a complication involving my adrenal gland and my blood pressure. Following everything with the ICU and going home, and seeing the endocrinologist to get some sort of confirmation on what exactly happened to me, I realized that I am not the only kid who's had to go through this following this surgery, and I certainly didn't have it the worst.

Carrying around the needle with an emergency dose of hydrocortisone and having to teach my friends how to use it made me feel fearful, even if this wasn't the biggest thing that's ever happened to me.

Through experiencing this, it made me wonder what about the kids whose surgery didn't work all together, or the kids who's rods break? How hard was this on them?

Maybe this research isn't the most pressing issue in our modern society, but I wanted a project that felt close to me, and this fit the bill exactly.

Most of the people I know who had the surgery didn't have any complications, and I'm grateful for that, but that doesn't eliminate those who did.

I read in an article that this surgery has a large rate of complications and have talked about rates in a previous post. It's hard to determine exactly why, but as someone who was given no answer as to why my blood pressure dropped so severely, I want to be able to seek it out (although I expect not much as I'm only a high school senior).

Week Eight Day One: In the Eyes of a Patient (pt. 2).

Before I describe what it was like after surgery, here are my x-rays before the operation.

My three curves were measured 34 degrees, 54 degrees, and 28 degrees, from top to bottom. Because that 54 is clearly above the 45-50 degree operative level, that meant I needed surgery. However, because I also had a chiari malformation (when the brain tissue extends into the spinal canal) I needed another surgery. I talked about this in an earlier post, how the brain tissue can cause syrinx (pockets of spinal fluid) to build up in the spine, and that can be dangerous for spinal fusion patients.

In my last post I talked about before the surgery, but now I'll talk about what happens after.

Most people stay in the ICU for one day, although Dr.Shindell is working to find a way to make that not necessary, where they're under high surveillance. Within the first day following the surgery, the doctors have the patient start walking, though with some assistance. I, on the other hand, had to stay in the ICU for two days, as I had a severe drop in blood pressure, causing me to go blue, and causing my parents to have to wait to see me for a few extra hours after.

I wish I could say that I remembered the hospital visit, but I don't, not one bit of it, so here's what my dad said about what I was like,

"You were very antsy, and wanted to be moved around every five minutes, most likely because your body was getting used to being at a different angle. You kept asking to be adjusted. We didn't know if your body was producing cortisol (the hormone they thought was causing your drop in blood pressure). You were very emotional, you wanted to make sure you weren't being a burden. You walked as fast as possible when they asked you to walk because you hated it."

Following about 6 days in the hospital, I was sent home, with a walker, and pain medication (which I didn't take much of after a little while).

For about three weeks, I was in bed, and occasionally following that time, I would leave my bedroom and start walking with the walker, only to sit in the living room chair instead, just for meals.

I didn't eat much, and lost about 11 pounds following the surgery.

Because they thought my body wasn't producing cortisol, they put me on a medication to try and boost the levels of that hormone, and even sent me around with a needle and liquid medication just in case I passed out.

I wasn't allowed to carry anything over 10lbs, and I very often got tired. My muscles ached more than anything, as they cut through a lot of muscle to get down to your spine. Even to this day, over 3 months since the surgery, I still get severe muscle pain in my shoulders when I do too much.

There's so much more that I experienced after the surgery that I either don't remember, or don't want to overwhelm you with, but I feel that these past two blog posts have been pretty informative.

Here is my spine now.

The curve is 28 degrees, which is very good, as very few surgeries actually get full fusion.

The reason I'm trying to study the complications now, is because I had a preoperative condition, and I had postoperative complications (the very low blood pressure) and I wanted to know if they are connected.

I still struggle with data, but with the small amount that I have plus some readings I found, I should be able to get some understanding, but of course this is just a high school project and not an actual government funded research.